A U.S. executive order has driven rapid adoption of Medicaid “most-favored-nation” (MFN) pricing and comparable prices in other high-income countries, according to reporting on participation rates by major drugmakers. By the end of 2025, 14 of 17 large manufacturers covered by the White House had signed voluntary agreements to price newly launched medicines comparably and to offer existing drugs to Medicaid at MFN rates. The remaining manufacturers later joined, with participation reaching about 89% of the branded market. An early market signal suggests MFN is affecting European launch activity, with one source estimating a roughly 35% year-over-year decline in EU new drug launches during the same window. Separately, U.S. and EU commercialization planning is being reshaped by tighter evidence expectations through the EU’s Joint Clinical Assessment (JCA) process and increased scrutiny by national HTA bodies such as NICE and Germany’s G-BA, including more use of real-world evidence (RWE).